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Here's your free report about AnterioRest® back support from the front. This free report discusses how AnterioRest® can help you alleviate back, neck and shoulder pain while you are practicing your profession.

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AnterioRest® Dental

Back Support From The Front

If you’re in the dental field I’m not surprised you have an interest in alleviating back, neck, shoulder, and even extremity pain and symptoms. Statistically these problems have increased over recent decades as many of you have become frustrated in your attempts at gaining relief in spite of your best efforts. Teachings have concentrated almost exclusively on postural correction as the solution and, as we’ll see, addresses only part of the problem in the profession. Since the advent of postural teaching decades ago, substantial information has come to light in the area of soft tissue dysfunction. Clinically, physical therapy professionals are seeing amazing results in relieving even what were thought to be chronic conditions when the appropriate tissue problem is addressed. Dentistry is one profession where posture correction has historically been attempted to alleviate muscle dysfunction and has had limited success. Some conditions can be helped with a postural correction if skeletal position is part of the problem. Sadly, the majority of the pain and dysfunction in dentistry is muscle related and postural corrections have not proven to be effective. When the appropriate tissue is addressed most often there is notable if not complete and often rapid relief of symptoms. This is not miraculous but rather applying the appropriate “fix” for the problem tissue. To understand the problem lets look at more detail of the possible tissues involved.

SKELETAL VS SOFT TISSUE

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When we treat a problem in orthopedic therapy we can divide the situation into two general areas-skeletal and soft tissue/muscular. I recognize that tendons, disc and other specific tissues may be implicated but they also fall into these two categories. There is often overlap, but for discussion let’s consider the two areas. Skeletal spine problems may include disc pressure/bulge, facet joint irritation, degenerative changes as we get older (often present but not a symptom generator in many), fractures etc (not a naturally occurring problem in dentistry.) Soft tissue problems include sprain/strain (tearing) of tissue-rarely seen without a noticeable force that impacts the area, contusion—again requiring a force input, and muscle overuse from prolonged/constant muscle contraction. This constant, or Sustained Muscle Contraction (SMA) requires no direct trauma to the tissue but occurs when a normal, even minimal contraction is continued for more than a short period of time A static muscle contraction causes a rise in internal pressure which compresses the vessels in the area resulting in a decrease in oxygen and nutrition to the area. The muscle becomes more dependent on anaerobic systems for energy which results in lactic acid accumulation. Pain and fatigue ensues. “Even a slight one-third of maximal effort is considered great if maintained for just four minutes or more”(Jennifer Lake-1).

UNSUCCESSFUL MODIFICATIONS

Attempts have been made to alleviate this muscle overuse activity in dentistry through postural correction. Maintaining any posture, even a “neutral” one causes the same cascade of events in the tissue. Lalumandier et al reports “muscle contraction is required to maintain the postures that dental professionals use when treating patients. If any position, even a neutral one is held too long, the muscles may fatigue and develop a tightness or spasm in response to this overworking of the muscle.” (Lalumandier _2). They also stated” An electromyographic study found that the trapezius (upper back/neck) muscle exhibited almost constant tension during dental procedures.” This isn’t a surprise as trying to maintain any position for extended periods will produce predictable results in the muscle. Wunderlich et al reported that in a study of German dentists 85% of their workday was spent in an isometric (constant contraction/no movement) position and that movements detected were rare and of small amplitude. They concluded there were no relevant differences between the 9 and 12 o’clock positions and that altering the operator’s basic position did not reduce the physiological stress. We see that although they were allowed to utilize various working positions, they were attempting to maintain these positions with little variation allowed. Again, attempting to maintain any position, even a neutral or good one is detrimental to tissue health.

TRY THIS!

The next time you go to a movie try to sit up in your dental posture—even take your lumbar roll with you. Then try to maintain that position throughout the movie as you would in the workplace. Bet it won’t take long before you’re distracted from the movie by your position. The position isn’t the problem but trying to maintain it is. Movement, not maintaining a single position, is key to tissue health. Lehto et al state “The concept of a single correct work posture may be physiologically invalid; it may be that the human body is rather made for movement and ever-changing postures.” (Lehto). To really hit the nail on the head we need to consider the ongoing problem of constant muscle contraction inherent in maintaining any position for more than short periods of time.

THIS MAKES SENSE

If muscle contraction is the problem, then not contracting the muscle must be the solution. If we can avoid static muscle contraction then adequate blood flow to the tissue is present and we avoid the cascade of events that lead to lactic acid build-up and pain dysfunction. We’ve already found the solution to the problem in your living room. You’re blessed with not having to watch the game while sitting on a milking stool. Yea! You have a backrest on your chair (probably a recliner) that allows you to sit comfortably without muscle effort. Try it next time on a stool without a backrest and you’ll long for your recliner. Notice that your recliner position itself isn’t a problem as you can enjoy the game even though you are not in a neutral or perfect posture. That’s because it’s not the position itself that’s the problem. Try assuming your reclined position without the backrest on your chair—ouch - not gonna happen for very long unless you have
superman abds!

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Note that you’re in the reclined position and your abds are working.If you move in to an inclined position your back/neck muscles will take the brunt of the abuse—DENTISTRY!! The position isn’t the problem any more than it is in your less than perfect position in your recliner. Actually the natural forward lean position seen in dentistry is well within normal parameters of movement for the spine and allows direct visualization of the oral cavity. Maintaining the position could be a problem however. What to do to stop the muscle contraction? Support - just like the backrest does for you on your recliner.

RESEARCH BASED

As early as 1975 Andersson and Nachemson recognized that support not only decreased muscle activity but also reduce disc pressure in the spine. They found that low back disc pressure was actually lower when the subject was writing when compared to typing and noted the difference was that in writing the arms were supported. This obviously in turn supported the trunk and resulted in decreased pressure in the disc. They go on to state “myoelectric activity and disc pressure are both comparatively low in writing, higher in typing, and still higher in lifting.” Support from the front (arms resting on the table in writing in a forward lean position) even had lower disc pressure than did sitting upright in the chair with arms relaxed at side. Support of the trunk proved to be vital to the decrease in both parameters. So what to do about dentistry?

DEFINITION OF IDEAL

“Good” Posture is not as important as support. An “Ideal” posture is one that’s fully supported for whatever task is being performed.

Ideal support of the trunk and upper extremities would be comfortable and not interfere with the direct visualization of the work site and allow continued full movement of the arms while maintaining a stable, adjustable mode of support from the front. I urge you to consider the AnterioRest as it has been specifically designed to meet all of the above needs in dentistry. No other profession has the ongoing degree of pain and dysfunction with as poor a history of alleviating those symptoms despite the best effort throughout the profession. The AnterioRest isn’t a gimmick but actually addresses the correct problem rampant in dentistry-muscle overuse. Some will have problems correctible with a postural approach but then there’s the rest. And it’s not a small number of those who continue their careers with pain and fatigue. In 1946 Biller reported the prevalence of back pain at 65 per cent. In 2005 JADA concluded that chronic musculoskeletal pain appears early in dental careers, with more than 70 percent of dental students of both sexes reporting pain by their third year. Even with close supervision and correction to maximize postural performance, symptoms flourished.

WHAT ABOUT THE OPERATOR STOOL?

Although the operator stool doesn’t address the problem of muscle overuse, a proper stool will provide improved skeletal position and allow the practitioner the freedom to change position. This affords the body opportunity to increase blood flow to areas as needed-the same as we do on a longer car ride or with prolonged sit during a movie, even as we often do during sleep. The stool should allow the operator to adjust height to allow hips to be slightly above the knees, swivel to allow turning without twisting, and adequate padding. A tiltable seat pan is beneficial and complimentary to anterior support, allowing the operator to assume an incline position and remain supported.

Proper Stool Adjustment

Keeps Lumbar Spine in Position

Allows Proper Anterior Pelvic Tilt

Allows Forward Lean without Hunching

Knees Apart

to Allow Forward Rotation

Without this support, in a forward lean once the operator is at or forward of the vertical position, muscle contraction is required to assume and maintain that position. When attempting to use a backrest for support, any body position forward of vertical negates the backrest support and actually requires more muscle effort to push the trunk “uphill” against gravity to maintain contact with the chair back. A forward tilt at the correct seat height with the AnterioRest allows direct visualization with proper spine position while achieving muscle relaxation. This ensures correct spine mechanics and addresses the ongoing problem of muscle overuse at the same time. Armrests on the operator stool have been utilized as a form of support of the trunk. However in this manner the muscle effort necessary to support the trunk in the desired working position is transferred to the shoulder girdle musculature requiring even further muscle activity in that area. By leaning on the elbow/forearm area the upper extremity is partially immobilized in that position limiting freedom of movement during the procedure.

Anterior Support Position

Support Above Center of Rotation

Arms free: No Stress Transferred to Shoulders

Stabilizes Torso At Focal Length

Maintains Proper Spine Alignment

PHYSICAL FITNESS

Another variable in all occupations is the basic level of fitness of the individual. While there are a plethora of reasons to stay fit, it will have limited effect for most in dentistry as static muscle contraction and the resulting limitation in blood flow will result in the same negative results in the muscle tissue. There are benefits to the tissue of stretching however to assist in muscle relaxation which in turn improves blood flow and oxygenation of local tissue. Don’t get me wrong, every human body benefits from regular stretching program, and dentistry is no different.

Fully Supported Seated Position

Knees Lower Than Hips

Knees Apart

Rotation From Hips

Torso Supported

Mirror Arm Supported

Proper Focal Length Supported

TRIGGER POINTS

Seen often in the case of muscle overuse occupations is the development of dysfunctional areas of muscle tissue called trigger points. Trigger points are areas of muscle fibers that are actually stuck in a contraction. At that point regardless of the persons activity or not (even while sleeping) the bundle of fibers cannot relax. The constant muscle contraction results in diminished blood flow and the predictable events leading to pain and dysfunction. In recent years treatment of this dysfunctional tissue has proven to be extremely effective in alleviating a wide variety of symptoms including pain and paresthesias distant from the problem area. Trigger point referral patterns have been mapped out for all muscles of the body and are seen multiple times per day in the orthopedic clinic. All patterns frequently mimic other standard diagnoses including migraine headaches, carpal tunnel syndrome, thoracic outlet syndrome, herniated disc, bursitis, tendonitis, and many others. Much of the pain and paresthesias in dentistry is trigger point related, very similar to what is seen in other sedentary occupations like musicians, draftsman, etc. These dysfunctional areas of muscle can be easily treated by one properly trained in trigger point release.

Trigger Points Common to Dentistry in BlackCommon Referred Pain locations in Red

Release may be accomplished manually or via TDN-trigger point dry needling. Here the practitioner palpates to disclose the actual trigger point and uses fine gauge needles to “needle” the point. Both techniques are effective in restoring the normal state of the muscle bundle regardless of the duration of the problem. The longest duration of trigger point activity I’ve seen in the clinic was 64 years. The patient’s chronic neck, upper back, and headache problem was successfully alleviated with trigger point release. Current myalgia (muscle pain) literature states “Pain management strategies must include the inactivation of relevant muscle trigger points combined with the elimination of all recorded predisposing, direct and indirect precipitating, and perpetuating factors.” (Franssen et al). Gerwin states “Chronic myalgia may not improve until the underlying precipitating or perpetuating factors are themselves managed.” He continues “Sometimes, correction of an underlying cause of myalgia is all that is needed to resolve the condition.”

I encourage you to consider the possibility of muscle overuse as a situation that can be eliminated in your practice. We all do it naturally on a daily basis—leaning on our elbows on the table as we eat or the desk as we read. Children intuitively support their arm with their other hand as they raise their arm in class to answer a question. Dentistry has had some problems addressed with postural correction. However, many continue to suffer and consider cutting back or even a career change due to their ongoing pain and fatigue. Isn’t it time to take the next step as many have and experience real comfort on the job thru anterior support. The AnterioRest provides this in a stable, comfortable, adjustable support. Let us help you enjoy your career.

Vary Your Position When Possible

Lean On the Support and Let Muscles Relax

Find “Home Position” for Each Procedure and Leave It…No Need to Move

Brief Periods Without Support are Not Harmful if Muscles Are Not Overworked